Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness that primarily affects infants and young children. It is caused by several different types of enteroviruses, most commonly, Enterovirus 71 (EV71) and Coxsackievirus A16 (CA16). This condition is characterized by fever, sore throat, and blister-like lesions on the hands, feet, and mouth.
HFMD was first recognized in New Zealand in 1957. However, it likely existed prior to that but was not formally identified. Initially, it was believed to be solely caused by Coxsackievirus A16. However, with the development of advanced laboratory techniques and improved diagnostic methods, other enteroviruses like EV71 were also identified as causative agents of HFMD.
HFMD is prevalent globally and is endemic in many parts of the world. However, it is more commonly reported in the Asia-Pacific region, including countries such as China, Japan, Singapore, Malaysia, and Taiwan. Outbreaks are more prevalent during the warmer months and tend to occur in cyclical patterns every few years. While the disease is also found in other regions, such as Europe, North America, and Africa, its incidence is lower.
Transmission of HFMD usually occurs through direct contact with nose and throat discharges, saliva, fluid from blisters, and feces of infected individuals. The virus can also spread through respiratory droplets, such as through coughing or sneezing. It can survive on surfaces outside the body for several hours, increasing the risk of transmission via contaminated objects or surfaces.
Although HFMD affects people of all ages, children under the age of five are most susceptible due to their developing immune systems and lack of previous exposure. In densely populated areas such as daycares, schools, and boarding facilities, there is an increased risk of transmission. Additionally, the virus can be transmitted from mother to baby during childbirth.
The major risk factors associated with HFMD transmission include poor personal hygiene practices, close contact with infected individuals, and crowded living conditions. Lack of proper handwashing, sharing of contaminated objects, and failure to cover the mouth and nose when coughing or sneezing contribute to the spread of the virus.
The impact of HFMD varies across different regions and populations. In the Asia-Pacific region, particularly in countries like China and Taiwan, large-scale outbreaks occur periodically, affecting thousands of children. The disease can lead to severe complications in some cases, including viral meningitis, encephalitis, myocarditis, and acute flaccid paralysis.
Prevalence rates and affected demographics can differ within regions and even within countries. For example, in China, HFMD cases are more prevalent in rural areas compared to urban regions. This disparity may be due to differences in healthcare access, sanitation, and population density. Certain demographics, such as young children in crowded environments, are at a higher risk of infection and severe complications.
In conclusion, HFMD is a globally prevalent viral illness primarily affecting children. The disease is transmitted through direct contact with infected fluids and feces, as well as respiratory droplets. Risk factors include poor personal hygiene, crowded living conditions, and close contact with infected individuals. HFMD has a significant impact on different regions and populations, with variations in prevalence rates and affected demographics. Efforts to prevent and control the disease focus on maintaining good hygiene practices, early detection, and appropriate medical care.

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Seasonal Patterns:
Based on the provided data, Hand, Foot, and Mouth Disease (HFMD) exhibits a consistent seasonal pattern in mainland China, with cases increasing during the summer months and decreasing during the winter months. This suggests a clear seasonal pattern, indicating higher transmission and occurrence of HFMD during warmer months.
Peak and Trough Periods:
The peak period for HFMD cases in mainland China is observed from June to August, with the highest number of cases occurring during these months. This indicates that the summer season is the peak period for HFMD transmission. Conversely, the trough period for HFMD cases is during the winter months, particularly from December to February, with a generally lower number of cases during this time.
Overall Trends:
Overall, the data demonstrates an increasing trend in HFMD cases in mainland China from 2010 to 2013, reaching its highest number of cases in 2012. After 2013, there is a fluctuating pattern with some years showing an increase or decrease in cases compared to the previous year. However, it is important to note that a significant increase in HFMD cases has been recorded starting from 2016, with the highest number of cases reported in July 2023.
Discussion:
The seasonal pattern and peak periods of HFMD in mainland China suggest that the disease is influenced by climatic factors, with higher transmission occurring during warmer months. This is consistent with the typical pattern of enteroviral diseases, including HFMD, which tend to thrive in the summer due to increased outdoor activities and close contact among individuals.
The overall increasing trend in HFMD cases from 2010 to 2013, followed by a fluctuating pattern in subsequent years, may be influenced by various factors, such as changes in population susceptibility, improved surveillance and reporting systems, and implemented interventions to control the disease.
Continued monitoring and study of the epidemiology of HFMD in mainland China are crucial to understanding the factors contributing to the increasing trend and implementing effective prevention and control strategies. This may include promoting hygiene practices, ensuring proper sanitation, and strengthening public health interventions during peak periods.